Biliary Complications After High-Grade Blunt Liver Trauma in Children: Impact of Early Recognition on Management Burden
- Journal
- Journal of pediatric surgery (Q1)
- Published
- 12 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Giulia Sollami, Lidia Rabiolo, Giuseppe Cristofalo, Davide Coppolino, Luigi Maruzzelli, Mariapina Milazzo, et al.
- PMID
- 42863656
- DOI
- 10.1016/j.jpedsurg.2026.163539
Why clinicians should know about it
- Picked for Pediatric Surgery (paper of the day, 14 October 2026): Early recognition reduces management burden
Abstract
BACKGROUND/PURPOSE: Biliary complications (BIC) are rare after high-grade blunt liver trauma in children, but a recognized source of morbidity. The main clinical issue is whether they are recognized in time to limit treatment burden. This study evaluated the incidence, presentation, and management of BIC after high-grade blunt liver trauma in a pediatric referral cohort. METHODS: All consecutive children younger than 18 years referred to a quaternary pediatric hepatobiliary center between January 2006 and December 2025 for severe blunt liver injury were retrospectively reviewed. Demographic data, injury grade, timing of diagnosis, treatment, and clinical outcomes were analyzed. Length of hospital stay was used as a surrogate marker of management burden. RESULTS: Eighteen BIC events were identified in 18 children, including 15 biliary fistulas and 3 bilomas. BIC occurred more often with increasing injury severity, affecting 20% of grade III, 50% of grade IV, and 67% of grade V injuries (P= 0.046). Median hospital stay was longer in children with BIC than in those without BIC (21 days [IQR, 16.5-33.5] vs 9.5 days [IQR, 7-13]; P = .007). In children who underwent planned second-look laparotomy after peri-hepatic packing, bile leak was recognized early, with trans-cystic drainage allowing single step cure; delayed diagnosis on the other hand was significantly associated with more complex and staged management, including percutaneous drainage, endoscopic or delayed interventions (P< 0.01). CONCLUSION: Timely recognition was associated with simpler management and shorter hospitalization, suggesting that structured surveillance of selected high-risk injuries should be incorporated into contemporary nonoperative management pathways.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.